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1.
Infectio ; 25(4): 262-269, oct.-dic. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1286720

RESUMO

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.


Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Biomarcadores , COVID-19 , Pacientes , Tabagismo , Comorbidade , Risco , Fatores de Risco , Mortalidade , Colômbia , Sobrepeso , Cursos , Infecções , Obesidade
2.
JAMA Netw Open ; 4(11): e2133090, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34779847

RESUMO

Importance: Antidepressant use may be associated with reduced levels of several proinflammatory cytokines suggested to be involved with the development of severe COVID-19. An association between the use of selective serotonin reuptake inhibitors (SSRIs)-specifically fluoxetine hydrochloride and fluvoxamine maleate-with decreased mortality among patients with COVID-19 has been reported in recent studies; however, these studies had limited power due to their small size. Objective: To investigate the association of SSRIs with outcomes in patients with COVID-19 by analyzing electronic health records (EHRs). Design, Setting, and Participants: This retrospective cohort study used propensity score matching by demographic characteristics, comorbidities, and medication indication to compare SSRI-treated patients with matched control patients not treated with SSRIs within a large EHR database representing a diverse population of 83 584 patients diagnosed with COVID-19 from January to September 2020 and with a duration of follow-up of as long as 8 months in 87 health care centers across the US. Exposures: Selective serotonin reuptake inhibitors and specifically (1) fluoxetine, (2) fluoxetine or fluvoxamine, and (3) other SSRIs (ie, not fluoxetine or fluvoxamine). Main Outcomes and Measures: Death. Results: A total of 3401 adult patients with COVID-19 prescribed SSRIs (2033 women [59.8%]; mean [SD] age, 63.8 [18.1] years) were identified, with 470 receiving fluoxetine only (280 women [59.6%]; mean [SD] age, 58.5 [18.1] years), 481 receiving fluoxetine or fluvoxamine (285 women [59.3%]; mean [SD] age, 58.7 [18.0] years), and 2898 receiving other SSRIs (1733 women [59.8%]; mean [SD] age, 64.7 [18.0] years) within a defined time frame. When compared with matched untreated control patients, relative risk (RR) of mortality was reduced among patients prescribed any SSRI (497 of 3401 [14.6%] vs 1130 of 6802 [16.6%]; RR, 0.92 [95% CI, 0.85-0.99]; adjusted P = .03); fluoxetine (46 of 470 [9.8%] vs 937 of 7050 [13.3%]; RR, 0.72 [95% CI, 0.54-0.97]; adjusted P = .03); and fluoxetine or fluvoxamine (48 of 481 [10.0%] vs 956 of 7215 [13.3%]; RR, 0.74 [95% CI, 0.55-0.99]; adjusted P = .04). The association between receiving any SSRI that is not fluoxetine or fluvoxamine and risk of death was not statistically significant (447 of 2898 [15.4%] vs 1474 of 8694 [17.0%]; RR, 0.92 [95% CI, 0.84-1.00]; adjusted P = .06). Conclusions and Relevance: These results support evidence that SSRIs may be associated with reduced severity of COVID-19 reflected in the reduced RR of mortality. Further research and randomized clinical trials are needed to elucidate the effect of SSRIs generally, or more specifically of fluoxetine and fluvoxamine, on the severity of COVID-19 outcomes.


Assuntos
Antidepressivos , COVID-19/mortalidade , Fluoxetina , Fluvoxamina , Inibidores de Captação de Serotonina , Índice de Gravidade de Doença , Adulto , Idoso , Antidepressivos/farmacologia , COVID-19/metabolismo , Citalopram/farmacologia , Citocinas/metabolismo , Feminino , Fluoxetina/farmacologia , Fluvoxamina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição , Estudos Retrospectivos , Risco , SARS-CoV-2 , Inibidores de Captação de Serotonina/farmacologia , Sertralina , Estados Unidos
4.
Front Immunol ; 12: 740260, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34745111

RESUMO

Increased left ventricular fibrosis has been reported in patients hospitalized with coronavirus disease 2019 (COVID-19). It is unclear whether this fibrosis is a consequence of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection or a risk factor for severe disease progression. We observed increased fibrosis in the left ventricular myocardium of deceased COVID-19 patients, compared with matched controls. We also detected increased mRNA levels of soluble interleukin-1 receptor-like 1 (sIL1-RL1) and transforming growth factor ß1 (TGF-ß1) in the left ventricular myocardium of deceased COVID-19 patients. Biochemical analysis of blood sampled from patients admitted to the emergency department (ED) with COVID-19 revealed highly elevated levels of TGF-ß1 mRNA in these patients compared to controls. Left ventricular strain measured by echocardiography as a marker of pre-existing cardiac fibrosis correlated strongly with blood TGF-ß1 mRNA levels and predicted disease severity in COVID-19 patients. In the left ventricular myocardium and lungs of COVID-19 patients, we found increased neuropilin-1 (NRP-1) RNA levels, which correlated strongly with the prevalence of pulmonary SARS-CoV-2 nucleocapsid. Cardiac and pulmonary fibrosis may therefore predispose these patients to increased cellular viral entry in the lung, which may explain the worse clinical outcome observed in our cohort. Our study demonstrates that patients at risk of clinical deterioration can be identified early by echocardiographic strain analysis and quantification of blood TGF-ß1 mRNA performed at the time of first medical contact.


Assuntos
COVID-19/fisiopatologia , Ventrículos do Coração/patologia , Miocárdio/patologia , Fibrose Pulmonar/fisiopatologia , SARS-CoV-2/fisiologia , Adulto , Idoso , COVID-19/imunologia , Feminino , Fibrose , Ventrículos do Coração/metabolismo , Humanos , Proteína 1 Semelhante a Receptor de Interleucina-1/genética , Proteína 1 Semelhante a Receptor de Interleucina-1/metabolismo , Masculino , Pessoa de Meia-Idade , Miocárdio/metabolismo , Neuropilina-1/genética , Neuropilina-1/metabolismo , Fibrose Pulmonar/imunologia , Risco , Índice de Gravidade de Doença , Fator de Crescimento Transformador beta1/genética , Fator de Crescimento Transformador beta1/metabolismo , Carga Viral
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(10): 1855-1862, 2021 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814624

RESUMO

Objective: To systematically summarize and assess risk prediction models for occurrence of cervical cancer and to provide evidence for selecting the most reliable model for practice, and guide cervical cancer screening. Methods: Two groups of keywords related to cervical cancer and risk prediction model were searched on Chinese databases (CNKI, and Wanfang) and English databases (PubMed, Embase, and Cochrane Library). Original articles that developed or validated risk prediction models and published before November 21, 2019, were selected. Information form was created based on the CHARMS checklist. The PROBAST was used to assess the risk of bias. Results: 12 eligible articles were identified, describing 15 prediction models, of which five were established in China. The predicted outcomes included multiple stages from cervical precancerous lesions to cancer occurrence, i.e., abnormal Pap smear (1), occurrence or recurrence of CIN (9), and occurrence of cervical cancer (5), etc. The most frequently used predictors were HPV infection (12), age (7), smoking (5), and education (5). There were two models using machine learning to develop models. In terms of model performance, the discrimination ranged from 0.53 to 0.87, while only two models assessed the calibration correctly. Only two models were externally validated in Taiwan of China, using people in different periods. All of the models were at high risk of bias, especially in the analysis domain. The problems were concentrated in the improper handling of missing data (13), preliminary evaluation of model performance (13), improper use of internal validation (12), and insufficient sample size (11). In addition, the problems of inconsistency measurements of predictors and outcomes (8) and the flawed report of the use of blindness for outcome measures (8) were also severe. Compared with the other models, the Rothberg (2018) model had relatively high quality. Conclusions: There are a certain number of cervical cancer risk prediction models, but the quality is poor. It is urgent to improve the measurement of predictors and outcomes, the statistical analysis details such as handling missing data and evaluation of model performance and externally validate existing models to better guide screening.


Assuntos
Neoplasias do Colo do Útero , Viés , Detecção Precoce de Câncer , Feminino , Humanos , Prognóstico , Risco , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia
6.
Indian J Med Res ; 154(1): 62-77, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34782531

RESUMO

Background &objectives: Women with gestational diabetes are at an increased risk of being diagnosed as type 2 diabetes, but the postpartum screening rate is low. To provide evidence-based data for health providers and promote postpartum screening, this systematic review and meta-analysis was conducted to access the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) in different demographic and maternal subgroups. Methods: MEDLINE, Embase and Cochrane Library were searched systematically. Unadjusted relative risks (RRs) and 95 per cent confidence intervals (CIs) were calculated and pooled using a random-effects model. Heterogeneity was assessed with Cochrane's Q text and by calculating I2 values. Subgroup analyses were conducted to address the disparities of type 2 diabetes conversion after gestational diabetes in different demographic and maternal subgroups. Results: 1809 publications were screened and 39 cohort studies including 2,847,596 women were selected. In these studies, 78,893 women were diagnosed as T2DM at six weeks or later after delivery. The unadjusted RRs of women diagnosed T2DM at six weeks or later after delivery ranged from 1.32 (95% CI, 0.46-3.37) to 47.25 (95% CI, 2.95-758.01) with a pooled unadjusted RR of 8.92 (95% CI, 7.84-10.14). Older women, women with a family history of diabetes, Black and non-Hispanic White women and women living in Europe and South-East Asia had a higher risk of developing T2DM after GDM. Interpretation & conclusions: It is suggested that healthcare providers may focus on older women with GDM and women with GDM and a family history of diabetes. Black and non-Hispanic White women with GDM may receive more attention, and healthcare providers, especially those in Europe and South-East Asia, may pay more attention to preventive measures for postpartum T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Programas de Rastreamento , Período Pós-Parto , Gravidez , Risco
7.
PLoS One ; 16(10): e0258121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597332

RESUMO

The COVID-19 global incidence rate among young adults (age 19-40) drastically increased since summer 2020, and young adults were often portrayed by popular media as the "main spreader" of the pandemic. However, young adults faced unique challenges during the pandemic due to working in high-risk, low-paying essential service occupations, as well as having higher levels of financial insecurity and mental burden. This qualitative study aims to examine the attitudes and perceptions of health orders of young adults to better inform public health messaging to reach this demographic and increase compliance to public health orders. A total of 50 young adults residing in British Columbia, Canada, were recruited to participate in focus group in groups of four to six. Focus group discussions were conducted via teleconferencing. Thematic analysis revealed four major themes: 1) risks of contracting the disease, 2) the perceived impact of COVID-19, 3) responsibility of institutions, 4) and effective public health messaging. Contrary to existing literature, our findings suggest young adults feel highly responsible for protecting themselves and others. They face a higher risk of depression and anxiety compared to other age groups, especially when they take on multiple social roles such as caregivers and parents. Our findings suggest young adults face confusion due to inconsistent messaging and are not reached due to the ineffectiveness of existing strategies. We recommend using evidence-based strategies proven to promote behaviour change to address the barriers identified by young adults through tailoring public health messages, specifically by using positive messaging, messaging that considers the context of the intended audiences, and utilizing digital platforms to facilitate two-way communication.


Assuntos
COVID-19/patologia , Saúde Pública , Adolescente , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Comunicação , Feminino , Grupos Focais , Humanos , Masculino , Pandemias , Percepção , Risco , SARS-CoV-2/isolamento & purificação , Mídias Sociais , Inquéritos e Questionários , Adulto Jovem
8.
PLoS One ; 16(10): e0258132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597334

RESUMO

This confirmatory research investigates the influence of risk framing of COVID-19 on support for restrictive government policy based on two web survey experiments in Russia. Using 2x2 factorial design, we estimated two main effects-factors of risk severity (low vs. high) and object at risk (individual losses vs. losses to others). First, focusing on higher risks had a positive effect on support for the government's restrictive policy. Second, focusing on the losses for others did not produce stronger support for the restrictive policy compared to focusing on personal losses. However, we found a positive moderation effect of such prosocial values as universalism and benevolence. We found that those with prosocial values had a stronger positive effect in the "losses for others" condition and were more willing to support government restrictive policy when others were included. The effects found in our experimental study reveal both positive and negative aspects in risk communication during the pandemic, which may have a great and long-term impact on trust, attitudes, and behavior.


Assuntos
COVID-19/patologia , Política de Saúde , Apoio Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/virologia , Surtos de Doenças , Feminino , Governo , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Federação Russa/epidemiologia , SARS-CoV-2/isolamento & purificação , Inquéritos e Questionários , Adulto Jovem
9.
Front Immunol ; 12: 733418, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603311

RESUMO

Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and abnormal fatigability due to the antibodies against postsynaptic receptors. Despite the individual discrepancy, patients with MG share common muscle weakness, autoimmune dysfunction, and immunosuppressive treatment, which predispose them to infections that can trigger or exacerbate MG. Vaccination, as a mainstay of prophylaxis, is a major management strategy. However, the past years have seen growth in vaccine hesitancy, owing to safety and efficacy concerns. Ironically, vaccines, serving as an essential and effective means of defense, may induce similar immune cross-reactivity to what they are meant to prevent. Herein, we outline the progress in vaccination, review the current status, and postulate the clinical association among MG, vaccination, and immunosuppression. We also address safety and efficacy concerns of vaccination in MG, in relation to COVID-19. Since only a handful of studies have reported vaccination in individuals with MG, we further review the current clinical studies and guidelines in rheumatic diseases. Overall, our reviews offer a reference to guide future vaccine clinical decision-making and improve the management of MG patients.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Miastenia Gravis/imunologia , Miastenia Gravis/patologia , SARS-CoV-2/imunologia , Autoimunidade/imunologia , Humanos , Tolerância Imunológica/imunologia , Vacinas contra Influenza/imunologia , Risco , Vacinação/efeitos adversos
11.
J Coll Physicians Surg Pak ; 31(10): 1244-1246, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34601853

RESUMO

Longitudinal studies for determining the risk of anxiety and depression among COVID-19 survivor healthcare workers are lacking. This study aimed to determine the risk of anxiety and depression among healthcare workers that survived COVID-19 infection through a six-month post-recovery follow-up. This was a cohort study conducted at the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, from 1st March to 30th August 2020. A total of 64 subjects participated. Hospital Anxiety and Depression Scale (HADS) was used for assessing the anxiety and depression symptoms. HADS has three score cutoff as normal, borderline abnormal and, abnormal anxiety/depression. For the purpose of the study, borderline and above scores were taken as positive for anxiety/depression. Data was analysed using STATA Corp 15.1. There was no increased risk of anxiety or depression six months post-COVID-19 infection in the infected HCW, compared to uninfected HCW. It is recommended to conduct longitudinal studies with large sample and longer follow-up. Key Words: Relative risk, Anxiety, Depression, HADS, COVID-19, Healthcare workers.


Assuntos
COVID-19 , Depressão , Ansiedade/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Feminino , Pessoal de Saúde , Humanos , Paquistão/epidemiologia , Projetos Piloto , Gravidez , Risco , SARS-CoV-2 , Inquéritos e Questionários , Sobreviventes , Centros de Atenção Terciária
12.
PLoS One ; 16(10): e0258229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34610052

RESUMO

BACKGROUND/AIMS: We measured the association between underlying chronic hepatitis B (CHB) and antiviral use with infection rates among patients who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. METHODS: In total, 204,418 patients who were tested for SARS-CoV-2 between January and June 2020 were included. For each case patient (n = 7,723) with a positive SARS-CoV-2 test, random controls (n = 46,231) were selected from the target population who had been exposed to someone with coronavirus disease 2019 (COVID-19) but had a negative SARS-CoV-2 test result. We merged claim-based data from the Korean National Health Insurance Service database collected. Primary endpoints were SARS-CoV-2 infection and severe clinical outcomes of COVID-19. RESULTS: The proportion of underlying CHB was lower in COVID-19 positive patients (n = 267, 3.5%) than in COVID-19 negative controls (n = 2482, 5.4%). Underlying CHB was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.57-0.74). Among patients with confirmed COVID-19, underlying CHB tended to confer a 66% greater risk of severe clinical outcomes of COVID-19, although this value was statistically insignificant. Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate (aOR 0.49; 95% CI, 0.37-0.66), while treatment was not associated with severe clinical outcomes of COVID-19. CONCLUSIONS: Underlying CHB and antiviral agents including tenofovir decreased susceptibility to SARS-CoV-2 infection. HBV coinfection did not increase the risk of disease severity or lead to a worse prognosis in COVID-19.


Assuntos
COVID-19/patologia , Hepatite B Crônica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/virologia , Estudos de Casos e Controles , Estudos de Coortes , Bases de Dados Factuais , Feminino , Guanina/análogos & derivados , Guanina/uso terapêutico , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Risco , Índice de Gravidade de Doença , Tenofovir/uso terapêutico , Adulto Jovem
13.
Sci Rep ; 11(1): 20569, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663823

RESUMO

The Brazilian Northern region registered a high incidence of COVID-19 cases, particularly in the state of Pará. The present study investigated the risk factors associated with the severity of COVID-19 in a Brazilian Amazon region of 100,819 cases. An epidemiological, cross-sectional, analytical and demographic study, analyzing data on confirmed cases for COVID-19 available at the Brazilian Ministry of Health's surveillance platform, was conducted. Variables such as, municipalities of residence, age, gender, signs and symptoms, comorbidities were included and associated with COVID-19 cases and outcomes. The spatial distribution was performed using the ArcGIS program. A total of 100,819 cases were evaluated. Overall, patients had the mean age of 42.3 years, were female (51.2%) and with lethality reaching 4.79% of cases. Main symptoms included fever (66.5%), cough (61.9%) and sore throat (39.8%). Regarding comorbidities, most of the patients presented cardiovascular disease (5.1%) and diabetes (4.2%). Neurological disease increased risk of death by nearly 15 times, followed by obesity (5.16 times) and immunodeficiency (5.09 time). The municipalities with the highest incidence rate were Parauapebas, Canaã dos Carajás and Jacareacanga. Similarity between the Lower Amazon, Marajó and Southwest mesoregions of Pará state were observed concerning the highest morbidity rates. The obtained data demonstrated that the majority of cases occurred among young adults, females, with the classic influenza symptoms and chronic diseases. Finally, data suggest that the highest incidences were no longer in the metropolitan region of the state. The higher lethality rate than in Brazil may be associated with the greater impacts of the disease in this Amazonian population, or factors associated with fragile epidemiological surveillance in the notification of cases of cure.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Adulto , Área Sob a Curva , Brasil/epidemiologia , COVID-19/mortalidade , Comorbidade , Tosse/epidemiologia , Estudos Transversais , Coleta de Dados , Feminino , Febre/epidemiologia , Geografia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise de Regressão , Risco , Fatores de Risco , SARS-CoV-2 , Adulto Jovem
14.
BMC Cancer ; 21(1): 1077, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34610807

RESUMO

BACKGROUND: The benefits of postoperative chemotherapy in patients with estrogen receptor (ER)-positive breast cancer remain unclear. The use of tumor grade, Ki-67, or ER expression failed to provide an accurate prognosis of the risk of relapse after surgery in patients. This study aimed to evaluate whether a multigene assay Curebest™ 95GC Breast (95GC) can identify the risk of recurrence and provide more insights into the requirements for chemotherapy in patients. METHODS: This single-arm retrospective multicenter joint study included patients with ER-positive, node-negative breast cancer who were treated at five facilities in Japan and had received endocrine therapy alone as adjuvant therapy. The primary lesion specimens obtained during surgery were analyzed using the 95GC breast cancer multigene assay. Based on the 95GC results, patients were classified into low-risk (95GC-L) and high-risk (95GC-H) groups. RESULTS: The 10-year relapse-free survival rates were 88.4 and 59.6% for the 95GC-L and 95GC-H groups, respectively. Histologic grade, Ki-67, and PAM50 exhibited a significant relationship with the 95GC results. The segregation into 95GC-L and 95GC-H groups within established clinical factors can identify subgroups of patients using histologic grade or PAM50 classification with good prognosis without receiving chemotherapy. CONCLUSIONS: Based on the results of our retrospective study, 95GC could be used to evaluate the long-term prognosis of ER-positive, node-negative breast cancer. Even though further prospective validation is necessary, the inclusion of 95GC in clinical practice could help to select optimal treatments for breast cancer patients and identify those who do not benefit from the addition of chemotherapy, thus avoiding unnecessary treatment.


Assuntos
Neoplasias da Mama/genética , Expressão Gênica , Recidiva Local de Neoplasia/genética , Receptores de Estrogênio , Análise Serial de Tecidos/métodos , Adulto , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/química , Neoplasias da Mama/classificação , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Perfilação da Expressão Gênica , Humanos , Japão , Antígeno Ki-67/análise , Linfonodos , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos , Risco , Taxa de Sobrevida , Fatores de Tempo
15.
Nutrients ; 13(10)2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34684371

RESUMO

BACKGROUND: Excessive intake of fructose, glucose and alcohol is associated with the development of non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD). At the same time, these dietetic factors create an environment favorable for the generation of advanced glycation end-products. For this reason, advanced glycation end-products (AGEs) are hypothesized to play role in the development of NAFLD and ALD. In this systematic review and meta-analysis, we explore the relationship between NAFLD and ALD with AGE levels, including their diagnostic accuracy. METHODS: The systematic review and meta-analysis has been pre-registered with PROSPERO (CRD42021240954) and was performed in accordance with the PRISMA guidelines. Meta-analyses were performed using the meta R package. RESULTS: We have obtained 11 studies meeting our inclusion criteria, reporting data on 1844 participants (909 with NAFLD, 169 with ALD and 766 healthy controls). NAFLD was associated with significantly higher AGE fluorescence and serum N-(carboxyethyl)lysine (CEL) levels. Patients with alcoholic cirrhosis had significantly higher levels of N-(carboxymethyl)lysine (CML). Only individual studies examined AGEs in the context of their diagnostic accuracy. AGE fluorescence distinguished low and moderate steatosis with an AUC of 0.76. The ratio of CML, CEL and pentosidine to a soluble variant of the AGE receptor differentiated patients with NAFLD from healthy controls with high AUC (0.83-0.85). Glyceraldehyde-derived AGE separated non-alcoholic fatty liver (NAFL) from non-alcoholic steatohepatitis (NASH) with acceptable performance (AUC 0.78). CONCLUSIONS: In conclusion, NAFLD and ALD are associated with significantly higher levels of several AGEs. More research is needed to examine the diagnostic accuracy of AGEs, however individual studies show that AGEs perform well in distinguishing NAFL from NASH.


Assuntos
Produtos Finais de Glicação Avançada/metabolismo , Hepatopatias/metabolismo , Animais , Estudos de Casos e Controles , Produtos Finais de Glicação Avançada/sangue , Humanos , Hepatopatias/sangue , Hepatopatias/diagnóstico , Viés de Publicação , Risco
16.
Nutrients ; 13(10)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34684478

RESUMO

Adequate nutritional status is necessary for the proper management of polypharmacy, the prevention of cognitive decline, and the maintenance of functional capacity in activities of daily living. Although several studies validate this fact for the general elderly population, data on institutionalized seniors concerning this relation are scarce. A systematic review was performed according to the PRISMA guidelines, aiming to study the potential correlation between nutritional status and polypharmacy, cognitive decline, and functional performance in institutionalized elders. The search was limited to studies in English or Portuguese in the last decade. Inclusion criteria relied on the PICO method. Five studies explored the relationship of nutritional status with cognitive performance in the institutionalized elderly, and nine prospective observational studies reported significant positive associations between appropriate nutritional status and physical abilities. Nutritional status was primarily measured by MNA. Adequate nutritional status was described as an important parameter in preventing cognitive and functional decline in the institutionalized elderly. No studies were found describing the impact of nutritional status on the prevention of polypharmacy. Given the strong impact of malnutrition found in the studies in cognition and functional abilities in the institutionalized elderly, an evaluation of nutritional status of the elders is crucial to prevent health problems and allow early intervention programs in order to further prevent health decline.


Assuntos
Cognição/fisiologia , Institucionalização , Estado Nutricional , Polimedicação , Idoso , Seguimentos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Viés de Publicação , Risco
17.
Nutrients ; 13(10)2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34684569

RESUMO

Cardiovascular diseases (CVDs) are the leading cause of death worldwide and obesity is a major risk factor that increases the morbidity and mortality of CVDs. Lifestyle modifications (e.g., diet control, physical exercise and behavioral changes) have been the first-line managements of obesity for decades. Nonetheless, when such interventions fail, pharmacotherapies and bariatric surgery are considered. Interestingly, a sudden weight loss (e.g., due to bariatric surgery) could also increase mortality. Thus, it remains unclear whether the bariatric surgery-associated weight reduction in patients with obesity and CVDs is beneficial for the reduction of Major Adverse Cardiovascular Events (MACE). Here, we performed a systematic literature search and meta-analysis of published studies comparing MACE in patients with obesity and CVDs who underwent bariatric surgery with control patients (no surgery). Eleven studies, with a total of 1,772,305 patients, which consisted of 74,042 patients who underwent any form of bariatric surgery and 1,698,263 patients with no surgery, were included in the systematic review. Next, the studies' data, including odds ratio (OR) and adjusted hazard ratio (aHR), were pooled and analyzed in a meta-analysis using a random effect model. The meta-analysis of ten studies showed that the bariatric surgery group had significantly lower odds of MACE as compared to no surgery (OR = 0.49; 95% CI 0.40-0.60; p < 0.00001; I2 = 93%) and the adjustment to confounding variables in nine studies revealed consistent results (aHR = 0.57; 95% CI 0.49-0.66; p < 0.00001; I2 = 73%), suggesting the benefit of bariatric surgery in reducing the occurrence of MACE in patients with obesity and CVDs (PROSPERO ID: CRD42021274343).


Assuntos
Cirurgia Bariátrica/efeitos adversos , Doenças Cardiovasculares/etiologia , Obesidade/cirurgia , Doenças Cardiovasculares/epidemiologia , Fatores de Confusão Epidemiológicos , Humanos , Incidência , Viés de Publicação , Risco
18.
Clin Appl Thromb Hemost ; 27: 10760296211039288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34595937

RESUMO

Coronavirus disease 2019 (COVID-19) is a systemic disease that can be life-threatening involving immune and inflammatory responses, and that can result in potentially lethal complications, including venous thrombo-embolism (VTE). Forming an integrative approach to thrombo-prophylaxis and coagulation treatment for COVID-19 patients ensues. We aim at reviewing the literature for anticoagulation in the setting of COVID-19 infection to provide a summary on anticoagulation for this patient population. COVID-19 infection is associated with a state of continuous inflammation, which results in macrophage activation syndrome and an increased rate of thrombosis. Risk assessment models to predict the risk of thrombosis in critically ill patients have not yet been validated. Currently published guidelines suggest the use of prophylactic intensity over intermediate intensity or therapeutic intensity anticoagulant for patients with critical illness or acute illness related to COVID-19 infection. Critically ill COVID-19 patients who are diagnosed with acute VTE are considered to have a provoking factor, and, therefore, treatment duration should be at least 3 months. Patients with proximal deep venous thrombosis or pulmonary embolism should receive parenteral over oral anticoagulants with low-molecular-weight heparin or fondaparinux preferred over unfractionated heparin. In patients with impending hemodynamic compromise due to PE, and who are not at increased risk for bleeding, reperfusion may be necessary. Internists should remain updated on new emerging evidence regarding anticoagulation for COVID-19 patients. Awaiting these findings, we invite internists to perform individualized decisions that are unique for every patient and to base them on clinical judgment for risk assessment.


Assuntos
Anticoagulantes/uso terapêutico , COVID-19/complicações , SARS-CoV-2 , Trombofilia/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Consenso , Estado Terminal , Gerenciamento Clínico , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fondaparinux/efeitos adversos , Fondaparinux/uso terapêutico , Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pacientes Internados , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações Hematológicas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/sangue , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Risco , Trombofilia/etiologia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
19.
Artigo em Inglês | MEDLINE | ID: mdl-34639661

RESUMO

Policy decisions about the accessibility of home birth hinge on questions of safety and affordability. Families consider safety and cost along with the comfort and familiarity of birthing venues. A substantial literature addresses safety concerns, generally reporting that for low-risk mothers in the care of credentialed midwives, the safety of planned home births is comparable to that in birth centers and hospitals. The lack of notable safety tradeoffs for low-risk mothers elevates the relevance of the economic efficiency of home births. The available cost figures for home births are largely out of date or anecdotal. The purpose of this research is to offer scholars, policymakers, and families improved estimates of both the cost of home births and the potential savings from greater access to home births. On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth. Further, we find that each shift of one percent of births from hospitals to homes would represent an annual cost savings to society of at least USD 321 million.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Tocologia , Feminino , Humanos , Recém-Nascido , Gravidez , Risco , Estados Unidos
20.
Gac Med Mex ; 157(3): 231-236, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34667311

RESUMO

INTRODUCTION: The scarcity of person-centered applications aimed at developing awareness on the risk posed by the COVID-19 pandemic, stimulates the exploration and creation of preventive tools that are accessible to the population. OBJECTIVE: To develop a predictive model that allows evaluating the risk of mortality in the event of SARS-CoV-2 virus infection. METHODS: Exploration of public data from 16,000 COVID-19-positive patients to generate an efficient discriminant model, evaluated with a score function and expressed by a self-rated preventive interest questionnaire. RESULTS: A useful linear function was obtained with a discriminant capacity of 0.845; internal validation with bootstrap and external validation, with 25 % of tested patients showing marginal differences. CONCLUSION: The predictive model with statistical support, based on 15 accessible questions, can become a structured prevention tool.


Assuntos
COVID-19/prevenção & controle , Modelos Estatísticos , Adolescente , Adulto , Idoso , COVID-19/mortalidade , Criança , Pré-Escolar , Análise Discriminante , Feminino , Humanos , Lactente , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Risco , Adulto Jovem
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